Helen Matzger

A prospective study of the factors influencing entry to alcohol and drug treatment.

Much is known about factors related to entering alcohol and drug treatment, but most research comprises cross-sectional “snapshots” in time. It is not known whether the reasons for entering treatment endure when problem drinkers are studied over time. This study contrasts characteristics predicting treatment entry in a cross-sectional analysis at baseline with a longitudinal perspective at 1- and 3-year follow-up interviews. Sociodemographic characteristics were less important in the longitudinal analysis. In contrast to the social consequences important at the baseline interview, physiologic symptoms of alcohol dependence and interventions by medical professionals were prominent at later interview points. The findings have implications for interventions by health professionals, both for the development of early interventions targeting individuals to treatment and for a continuing care service model.Much is known about factors related to entering alcohol and drug treatment, but most research comprises cross-sectional “snapshots” in time. It is not known whether the reasons for entering treatment endure when problem drinkers are studied over time. This study contrasts characteristics predicting treatment entry in a cross-sectional analysis at baseline with a longitudinal perspective at 1- and 3-year follow-up interviews. Sociodemographic characteristics were less important in the longitudinal analysis. In contrast to the social consequences important at the baseline interview, physiologic symptoms of alcohol dependence and interventions by medical professionals were prominent at later interview points. The findings have implications for interventions by health professionals, both for the development of early interventions targeting individuals to treatment and for a continuing care service model.

Missed Opportunities in Addressing Drinking Behavior in Medical and Mental Health Services

BACKGROUND Epidemiological and clinical literature point to the importance of screening for alcohol problems in medical and psychiatric settings. However, little is known about which problem drinkers seek help from those services or about the characteristics of those who have their drinking addressed. METHODS We interviewed a probability sample of adult dependent and problem drinkers in the general population (n = 672) and consecutive admissions to chemical dependency programs in a northern California county (n = 926). We reinterviewed them 1 year later and measured medical and mental health visits and whether their drinking was addressed during the visit. RESULTS Almost two-thirds of problem drinkers had a medical visit, and approximately one-third had a mental health visit, yet drinking was not often discussed, especially during medical visits. Many of those more likely to have a visit were not more likely to have their drinking addressed. Women and individuals older than 40 years had more medical and mental health visits [odds ratio (OR), 1.71; p < 0.001 and OR, 1.55; p < 0.001, respectively, for women; OR, 1.57; p < 0.05 and OR, 1.64; p < 0.05, respectively, for age >/=40 years], but were not more likely to have their drinking addressed in either setting, and women were less likely than men to have their drinking addressed in mental health settings (OR, 0.62; p < 0.05). Those with higher alcohol severity and those who had attended chemical dependency treatment during the previous year were more likely to have their drinking addressed in each setting. Insurance status predicted medical, but not mental health, visits and was not related to having drinking addressed in either setting. CONCLUSIONS Drinking behavior was not routinely addressed by medical and mental health practitioners for dependent and problem-drinking men and women who presented in public and private medical and mental health settings.

Sources of informal pressure on problematic drinkers to cut down or seek treatment

Objective: To examine how patterns of expressions of concern about drinking from family members and friends differ according to the demographic characteristics of the drinker. Method: A probability sample of adult treated (n=926) and untreated (n=672) problem‐drinking individuals from a Northern California county. Logistic regression analysis was used to predict having received pressure about drinking from a specific family member or friend. Results: Spouses and significant others were the most common relations to have said anything about the respondents drinking, suggested they cut down or given an ultimatum to enter treatment. When controlling for severity, the respondents degree of dependence and number of social consequences strongly predicted pressure from all sources. Having a higher income remained a strong predictor of pressure by a spouse, while having a lower income was significant in receiving pressure from siblings and other relatives and friends. Younger respondents were more likely to be pressed by a father or mother, while older respondents were more likely to be pressed by sons and daughters. Conclusions: Results show the importance of family relationships other than that with a spouse or significant other, in the efforts at informal control of drinking and efforts to seek treatment.

Alcohol Consumption, Risk of Injury, and High-Cost Medical Care

This study examined the effect of alcohol use on the probabilities of injury, inpatient hospital stay, and emergency department visit. Data were obtained from a sample of adults (N=1219) recruited from a Northern California county. Alcohol use measures included number of drinks, heavy drinking days, and an indicator variable for problem drinking. Models were estimated for men and women separately while controlling for confounders. Results indicate that most alcohol use measures were not significantly related to injury probability or medical care utilization. Among the exceptions, problem drinking was a significant positive predictor of any emergency department visit for both sexes. When drinkers during the past year were divided into light, moderate, and heavy drinking groups and compared to lifetime abstainers, all male drinkers had a higher probability of injury, and light and moderate female drinkers had a lower probability of an emergency department visit.

Addiction treatment history, medical services utilization, and cost: a longitudinal analysis of problem drinkers.

Abstract Few studies have examined the long-term patterns of health services utilization and cost for alcohol use disorders. This paper used data from baseline, 3-year, and 5-year follow-up interviews to compare utilization and cost of medical care services for problem drinkers who received chemical dependence treatment and those who did not. The analysis examined overnight hospital stays, emergency room visits, and medical office visits. The unadjusted analysis indicates that in the year immediately preceding each follow-up period, a significantly higher percentage of the chemical dependency treatment group stayed overnight at a hospital or used ER services. In terms of medical office visits, a significantly lower percentage of the treatment sample had office visits at the 5-year follow-up, but otherwise no significant differences existed. Most of the significant differences between the two groups vanished when we controlled for covariates. Researchers, policy makers, and clinicians could benefit from such information to develop alternative delivery models, formulate research initiatives, and determine areas for potential intervention and improvement.